Universal Precautions

A patient cannot be forced to stay in their side-room; a hospital cannot deny a patient their liberty, however if the patient should leave their room they should leave the clinical area e.g. visit the canteen or hospital shop. They should be encouraged to wash their hands on leaving the room. Patient’s rooms should be clearly labelled with the type of precautions in place. Every healthcare staff member has a responsibility to follow their hospital’s guidelines for these types of precautions. Source IsolationPatients with transmissible infectious diseases should be nursed in single occupancy rooms (side-rooms) with en-suite toilet and separate hand hygiene facilities. The door should remain closed at all times. Some patients need to be nursed in negative pressured rooms, which draw air into the room thereby preventing airborne microorganisms exiting to other clinical areas.

Protective IsolationPatients who are immunodeficient should be nursed in single occupancy rooms (side-rooms) with en-suite toilet and separate hand hygiene facilities. The door should remain closed at all times. Some patients will need to be nursed in positive pressured rooms, which push air out of the room thereby preventing airborne microorganisms entering the room and exposing the patient.

Hand Hygiene

Hands are the most common source of contamination leading to patient-to-patient transmission of infectious microorganisms. Effective hand hygiene is therefore the single most important step healthcare staff can take in order to prevent transmission of infections between patients.

The World Health Organisation’s 5 Key Moments of Hand Hygiene:1. Before patient contact2. Before an aseptic task3. After body fluid exposure risk4. After patient contact5. After contact with the patients surroundings

When to use Soap and Water or Alcohol Hand Gel:• Use soap and water when hands are visibly soiled and after caring for patients with diarrhoea• Use alcohol hand gel when hands appear clean but require antisepsis, between patient contacts and before and during aseptic techniques

Personal Protective Equipment (PPE)

Personal protective equipment is used to prevent members of staff acquiring infections as well as preventing their clothing from becoming contaminated with infectious microorganisms. PPE includes gloves, plastic aprons, goggles, visors and face masks.Gloves (contact)• Should be worn when handling blood and other body fluids, drainage material, invasive devices such as catheters and equipment that has been in contact with infective patients• Should NOT be worn continuously but should be removed when the task has been completed and definitely between patientsPlastic Aprons (splashes)• Should be worn when there is a risk of splashing with body fluids• Should NOT be worn continuously but should be removed when the task has been completed and definitely between patients

Goggles or Medical Visors (splashes)• Should be worn when there is a risk of splashing of body fluids into the eyes or mouth e.g. intubation, nasopharyngeal aspiration, tracheostomy care, chest physiotherapy, bronchoscopy, cardiopulmonary resuscitation, open suctioning of the airway• Should NOT be worn continuously but should be removed when the task has been completed and definitely between patientsFace Masks (airborne)• Should only be worn when there is a risk of airborne spread of infection such as during aerosol generating procedures (as per procedures under Goggles or Medical Visors above)• Should NOT be worn continuously but should be removed when the task has been completed and definitely between patientsPPE Usage and Side-roomsIt is necessary for staff to put on PPE every time you enter a side-room. Exceptions to PPE usage for staff, patients and visitors include:• Where there will be no contact with the patient or their immediate environment e.g. members of the MDT on a ward round who are observing• In an emergency situation e.g. patient about to remove CVC or ETT or fall. Attend to the emergency and then decontaminate. Encourage Emergency Medical Team (Crash Team) to use PPE if situation allows• Porters moving patients around the hospital who are only dealing with the patient’s environment. Deliver the patient and then decontaminate self and equipment e.g. hands/trolley/wheelchair• Visitors of a patient should be encouraged to wash their hands on exit. They may choose to wear PPE if assisting in care giving but as they do not risk transferring microorganisms to another patient they are not obliged to wear PPE• Patients who are in a side-room can leave without PPE but they should be encouraged to wash their hands on exit. For MDR TB the patient must wear a FFP3 mask when moving around the hospital. For precautions regarding MDR TB (see section - Infection Control, Multidrug Resistant TB)